Individual
MRS. HEATHER S DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
10049 E DYNAMITE BLVD, SUITE 110, SCOTTSDALE, AZ 85262-3694
(602) 510-2140
Mailing address
11227 E SHERIDAN AVE, MESA, AZ 85212-7052
(602) 510-2140
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1861
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
649808
—
AZ
Enumeration date
08/11/2006
Last updated
01/14/2013
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